Chapter 18: Lungs Flashcards
What does APGAR stand for?
Activity, Pulse, Grimace, Appearance, Respiration
Why are smaller airways a concern for infants and children?
- Concern because they can choke easier due to occlusion
- Inc. chance of asthma
- Increased risk of SIDS (sudden infant death syndrome)(First year of life)
Are irregular respirations normal for infants? If it is, when it it considered not ok?
- It is normal BUT…. if lasts longer than 15 sec or baby changes color it is an issue
- If its less then or greater than the range it isn’t good (30-60 respirations per minute)
- Not breathing is not ok
Apnea
Cessation of breathing due to the muscles stopping
normal for infants but cant last longer than 15 seconds
How do you count respirations?
Counting the number of breaths a patient takes for one full minute
Second hand smoking increases risks for what?
Increases risk for SIDS, asthma, cancer, and emphysema, negative effects on the heart
SIDS
Sudden Infant Death Syndrome
-Unknown cause of death in infants or children under the age of 1
What happens during inspiration?
Ribs move down and out, Lung volume increases, air pressure falls, Diaphragm contracts and flattens (moving down)
What happens during Expiration?
Ribs return to resting position, Lung volume decreases, air pressure rises, diaphragm relaxes
Developmental considerations in pregnant females
Respirations are deeper, Tidal volume increases by 40%, Diaphragm elevates, Physiologic dyspnea so increased awareness to breathe because diaphragm, Muscles and cartilage relax, fetus increases oxygen demand
Developmental competency in the aging adult
Decrease in respiratory efficiency because lungs lose elasticity, respiratory depth decreases, Decrease in cough ability, Respiratory rate increases b/c shallow breathing, Residual volume is greater, Barrel chest, Kyphosis, Fatigue
Who is at higher risk of asthma?
Blacks, Hispanics, and American Indians experience more asthma-related problems and medical care than do Whites or Asians.
Orthopnea
Shortness of breath when lying flat
May say they need a lot of pillows to sleep and can only sleep sitting up
Night sweats are common with which patients
Common with patients with TB
Green/yellow sputum
Bacterial infection
Clear sputum
Allergies or viral
Pink sputum
Pulmonary edema or COPD
Bloody sputum
Throat irritation or TB
Indicators of respiratory distress
Labored breathing, rapid breathing, muscle fatigue, Low BP, discolored skin/nails, fever, headache, difficulty breathing, cyanosis, flaring of nostrils, shallow breathing, grunting, Apnea, Patient gets tired when talking
Subcostal and substernal retractions are due to what?
result from lower respiratory tract disorders
Suprasternal retractions are usually from what?
upper respiratory tract disorders
Are mild intercoastal retractions normal?
Yes
What do deep suprasternal retractions indicate?
Severe stress
Crepitus
grating sound or sensation produced by friction between bone and cartilage or the fractured parts of a bone. Pocket of air trapped
Fremitus
palpable vibration.
Tactile fremitus
Use either palmar base (ball) of fingers or ulnar edge of one hand, and touch person’s chest while he or she repeats words, “ninety-nine” or “blue moon.”
-These are resonant phrases that generate strong vibrations.
Where are the sounds generated when doing the tactile fremitus test
Sounds generated from larynx are transmitted through patent bronchi and through lung parenchyma to chest wall, where you feel them as vibrations.
What sound should you hear in infants lungs vs adult lungs?
Hyper resonant in infants and Resonant in adults
Where should you listen for lung sounds?
- Posterior from apices at C7 to bases around T10
- Laterally from axilla down to seventh or eighth rib
3 areas to check lung sounds
Bronchial, Bronchovesicular (sternum area), Vesicular
Crackles
High pitched
End of inspiration
-Pneumonia, heart failure, bronchitis, asthma, COPD
Medium Crackles
Medium pitches
Sound heard about halfway through inspiration
-Pneumonia, heart failure, bronchitis, asthma, COPD
Coarse crackles
Low pitched, bubbling or gurgling
- Early in inspiration
- Pneumonia, heart failure, bronchitis, asthma, COPD, terminally ill patients, pulmonary edema, pulmonary fibrosis
Wheeze
High pitches, musical sound
- Expiration (mainly) or inspiration
- Narrow airway diseases like asthma
Rhonchi
Low pitched, coarse, loud, moaning tone (like snoring)
- Expiration
- Obstruction of trachea or bronchus
Pleural friction rub
Superficial, low pitched, coarse rubbing or grating sound
- Heard in inspiration and expiration
- Heard in individual with pleurisy (inflammation of pleural surfaces)
Stridor
-High pitched, monophonic, inspiratory, crowing sound; louder in neck than over chest wall
Originating in the larynx or trachea
-upper airway obstruction from swollen, inflamed tissues or lodged foreign body
-Croup and acute epiglottitis in children and foreign inhalation; obstruction airway may be life-threatening
Atelectatic crackles
- fine crackles, do not last, disappear after a few breaths, heard in the base usually
- Due to when alveoli are not fully aerated and are deflated
- In aging adults usually
Children have barrel chest (chest around 2 cm smaller than head) when they are little, when does the head to chest become a 1:2 ratio
Age 6
When should you take respirations in an infant
- Obtain the most accurate respiratory rate by counting when the infant is asleep because infants reach rapid rates with very little excitation when awake.
- Respiratory pattern may be irregular when extremes in room temperature occur or with feeding or sleeping.
What adventitious sounds are commonly hear in newborns
Fine crackles
Tachypnea
abnormal rapid breathing
Bradypnea
abnormal slow breathing
Hyperventilation
fast shallow breaths
Hypoventilation
slow shallow breathing
Cheyne - Stokes respiration
an abnormal pattern of breathing characterized by progressively deeper, and sometimes faster, breathing followed by a gradual decrease that results in a temporary stop in breathing called an apnea (30 seconds to 2 minutes)
Biots respiration
an abnormal pattern of breathing characterized by groups of quick, shallow inspirations followed by regular or irregular periods of apnea
Chronic obstructive breathing
COPD, emphysema and chronic bronchitis
Barrel chest is common in which patients
COPD
Cystic fibrosis
Elderly Patients
Pectus excavatum
Funnel chest
Breastbone sticks into the chest
Scoliosis
Lateral curvature of the spine, severe impairs breathing, slight scoliosis wont impair breathing
Kyphosis
Hunchback
Pectus carinatum
Pigeon chest, breastbone pushed out
Atelectasis
Collapsed shrunken section of the alveoli or an entire lung as a result of airway obstruction, compression of the lung, lack of surfactant
Lobar pneumonia
Infection in lung parenchyma leaves alveolar membrane edematous and porous, thus RBCs and WBCs pass from blood to alveoli
“Consolidation” (alveoli filled with fluid, bacteria, RBC, WBC) common used when talking about pneumonia
-crackles and wheezing
Bronchitis
Acute infection of the trachea and larger bronchi characterized by chronic cough, usually viral. Epithelium of bronchi inflamed. Large airways narrowed from capillary dilation, increased mucus production, loss of cilia function, and swelling epithelium.
Emphysema
Caused by destruction of pulmonary connective tissue; characterized by permanent enlargement of air sacs distal to terminal bronchioles and rupture of interalveolar walls. Increased airway resistance. Cigarette smoking is the main cause
(hyperresonant)
Asthma (reactive airway disease)
An allergic hypersensitivity to certain inhaled allergens, irritants, microbes, stress or exercise that produces a complex response. Vasoconstriction and inflammation
Pleural effusion
collection of excess fluid in the intrapleural space with compression of overlying lung tissue
-tactile fremitus is decreased or absent
Pneumothorax (3 causes)
Free air in pleural space causing partial or complete lung collapse. Usually unilateral. Can be 1) spontaneous with air entering pleural space through rupture in lung wall 2) traumatic air entering because injury to the lung wall 3) tension due to trapped air in pleural space increases, compressing the lung
Hemothorax
is a collection of blood in the space between the chest wall and the lung (the pleural cavity). Decreases space in the pleural cavity
Heart failure
Pump failure with increasing pressure on cardiac overload causing pulmonary congestion or an increased amount of blood present in pulmonary capillaries and air sacs deflate. Pulmonary capillaries engorged. Bronchial mucosa swollen
Pulmonary edema
buildup of fluid in the air sacs, pinkish, frothy sputum, usually due to congestive heart failure. You will hear crackles
Tuberculosis
inhalation of tubercle bacilli into the alveolar wall starts 1) initial complex is acute inflammatory response - macrophage engulf bacilli but do not kill them and tubercle turns to bacilli 2) scar tissue forms, lesions calcify 3) reactivation of previously healed lesions, dormant bacilli multiply producing necrosis, cavitation and caseous lung tissue 4) extensive destruction as erosion erodes into bronchus, forming air filled cavity
Pulmonary embolism
Undissolved materials like a thrombus or fat globule that dislodges in the leg or pelvis and travel through venous system into the right heart and lodges causing pulmonary occlusion resulting in ischemia
Lung cancer
Most fatal of malignancies, major cause is tobacco use and smoking. Four types: squamous ( central bronchi) Adenocarcinoma (periphery and escapes early detection) Large cell (periphery and tumors clustered) Small cell ( oat cell, compresses and narrows central bronchi)
Why do you check hemoglobin levels when doing a CBC?
Assess for anemia to see how well the oxygen is perfusing through the body
Why do you check WBC levels?
To see if there is an infection
What should SP02 be between?
95 - 100
When would you do a sputum evaluation
If patient has TB
How would you check for impaired gas exchange?
ABG
O2 stats
Hyper-hypo ventilation
Early hypoxia sign
Restlessness, Anxiety, Tachycardia
Late hypoxia signs
Bradycardia, Extreme restlessness, Dyspnea
Hypoxia in pediatrics
Feeding difficulty, Inspiratory stridor, Nose flares, Expiratory grunting, Sternal retractions
Dyspnea
difficult or labored breathing
Orthopnea
shortness of breath (dyspnea) that occurs when lying flat, causing the person to have to sleep propped up in bed or sitting in a chair.
Hemoptysis
is the coughing up of blood or blood-stained mucus from the bronchi, larynx, trachea, or lungs
Hypoxemia
an abnormally low concentration of oxygen in the blood.
Phlegm
thick viscous substance secreted by the mucous membranes of the respiratory passages
Sputum
a mixture of saliva and mucus coughed up from the respiratory tract, typically as a result of infection or other disease and often examined microscopically to aid medical diagnosis.
Tussive
means relating to or involved in cough
Expectorate
cough or spit out (phlegm) from the throat or lungs.
Asphyxia
a condition arising when the body is deprived of oxygen, causing unconsciousness or death; suffocation.
Hypoxia
deficiency in the amount of oxygen reaching the tissues
Cyanosis
a bluish discoloration of the skin resulting from poor circulation or inadequate oxygenation of the blood.
COPD
Chronic Obstructive Pulmonary Disorder
ABG
Arterial Blood Gas
SOB
Shortness of breath
URI
Upper respiratory infection
CXR
Chest X ray
MDI
Metered Dose inhaler
PNM
Perinatal mortality
LOC
Level of consciousness
SP02
Peripheral Capillary Oxygen Saturation
